Focus On Adherence On International Patient Safety Day

One of the clearest messages to emerge from this year’s international patient safety day (17 September) was the need for improving medication adherence rates. According to The World Health Organisation (WHO), 50 percent of people in developed countries neglect to follow medication prescriptions, either partially or completely. Poor adherence tends to lead to a lower quality of life, preventable deaths and avoidable medical spending – amounting to $105 billion a year in the US alone.

What’s more, errors in medication administration are the most frequent cause of so called adverse drug reactions (ADRs). Their consequences range from minor health disorders through to death. ADRs are responsible for five percent of all hospital admissions – two percent of which end up being fatal.

The need for better adherence practices has never been greater – in the past 50 years epidemiologists have noted a marked shift in global disease burdens from acute to chronic conditions, meaning more people are taking medication for longer periods of time. So without a system that addresses the reasons for poor adherence, no amount of new biomedical technology will have lasting results.

One WHO report even goes so far as to argue that successfully improving patients’ adherence to medication prescriptions may have a far greater impact on the health of a population than any improvement in specific medical treatments.

Big business has had access to these statistics for years, but only recently has it been able to offer a solution: That solution comes in the form of apps. Cheap or sometimes free, apps are easy to understand and can be introduced into populations with relative ease. They also offer a mobile way of giving interactive instructions to patients.

The latest German app in the world’s arsenal of adherence is MedHilfe by ratiopharm. In collaboration with doctors, pharmacists and patients, the developers created intuitive symbols for the interface that are aimed at overcoming language barriers. The app also provides audio instructions in 11 languages to guide patients through their treatment regimen.

Medihilfe’s audio features are just one of many approaches that adherence apps take to engage patients. PatientPartner, to name another example, uses gamification instead. It turns patient health education into a “choose your own adventure game” that patients can play while sitting in a doctor’s waiting room. Patients are prompted to earn points by selecting a character and then making choices that affect their character’s health. At the end their scores are tallied up in categories such as health education, health strategy, and emergency response.

A more visual strategy is employed by an app called Medisafe – with over 1 million downloads it is one of the most popular adherence apps in the Google play store. It captures the colour and shape of a patient’s medications as well as their dosages and schedules, and illustrates all this in a “virtual pillbox”. The app then sends patient push notifications when it’s time to take the meds, and notifies a friend or family member if the patient forgets. Medisafe even has a low tech version that sends reminders through automated phone calls and text messages.

Though apps have tremendous potential to alleviate adherence problems, researchers warn that these digital helpers should not be seen as a silver bullet. Poor adherence rates have many roots, all of which need to be addressed for improvement to be possible. These include social and economic factors, the health care team/system, the characteristics of the disease, disease therapies and a number of patient-related factors.

The formal and informal support patients receive also need to be taken to consideration in adherence methodology. There is substantial evidence that peer support among patients can improve adherence to therapy while reducing the amount of time required of health professionals. In short: technological improvements need to be accompanied by social and systemic action to have a fighting chance at effecting real change.
More research is needed to scientifically prove the links between apps usage and better adherence rates. In the meantime, at the very least they appear to be a promising component of a much needed solution.